UCSF researchers, in collaboration with colleagues at two other tertiary medical centers, determined that patients with multilevel airway stenosis (MLAS) have lower tracheostomy decannulation rates and require more surgeries than patients with posterior glottic stenosis (PGS).
“Our study found that patients with multilevel airway stenosis need more surgeries to improve the airway than those who don’t have that degree of stenosis. I don’t know that this has ever specifically been described before,” said UCSF otolaryngologist VyVy Young, MD, FACS, the study’s lead author. “This information is very valuable in terms of making treatment decisions and counseling patients on what to expect.”
Leveraging collective experiences
In their clinical practices, Young and the other researchers observed the challenges faced by patients. “Despite multiple surgeries, some patients with airway stenosis still struggle with breathing, swallowing and voice difficulties,” she said. “We wanted to better understand what was going on with these patients so we could more effectively help them. We conducted this retrospective study to put our collective experiences together and learn from them.”
The researchers identified 158 patients with PGS, MLAS or bilateral vocal fold paralysis (BVFP) treated between 2016 and 2021. Of those patients, 72.3% required tracheostomy. Patients with MLAS had higher rates of tracheostomy than those with BVFP. Compared to patients with PGS, the MLAS group had lower decannulation rates and required more surgeries.
“Patients want to know if we can get the tracheostomy tube out, what the risks are, how long it will take and what to expect afterward,” Young said. “They appreciate having this information so they can decide for themselves what’s an acceptable trade-off in terms of breathing, voice and swallowing function and what’s not. Realistic expectations are key.”
Young and her collaborators have started working on a multi-institutional prospective study on airway stenosis. “We’ll use the information from our prior experiences to help guide us in our next steps,” she said. “I invite other researchers interested in getting involved with this prospective study to reach out.”
Inquiry, innovation and collaboration
In her research and clinical practice, Young works with colleagues across various departments. “UCSF has an environment that invites inquiry, innovation and collaboration,” she said. “Our proximity to Silicon Valley spurs a lot of people here to be imaginative and creative and to partner with others, both in and outside of medicine, in ways that I haven't seen at other institutions. This inspires and excites.”
To learn more
UCSF Voice and Swallowing Center
Phone: (415) 885-7700, Fax: (415) 885-7800